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HomeMy WebLinkAboutMINUTES - 09261995 - C39 0,31 TO: BOARD OF SUPERVISORS Contra FROM: Mark Finucane, Health Services Director Costa DATE: September 8, 1995 County SUBJECT: Approval of Non-Physician Services Contract #27-056-5 with Robert Turcios, O.D. SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION I. RECOMMENDED ACTION: Approve and authorize the Health Services Director, or his designee (Milt Camhi) to execute on behalf of the County, Non-Physician Services Contract #27-056-5 with Robert Turcios, O.D. , for the period from October 1, 1995 through September 30, 1996, for provision of professional optician services. II. FINANCIAL IMPACT: This Contract is funded by member premiums. Cost to the County' depends upon utilization. As appropriate, patients and/or third party payors will be billed for services. III. REASONS FOR RECOMMENDATIONS/BACKGROUND: For a number of years the County has contracted with medical and dental specialists to provide for patients, specialized professional services which are not otherwise available in its hospital and clinics. The Contra Costa Health Plan has been obligated to provide professional optician services, including eyewear, for Health Plan patients with optician services as a covered benefit. This population includes Medi-Cal and Medicare patients, and County employees enrolled in the Health Plan. Approval of Non-Physician Services Contract #27-056-5 will allow the Contractor to provide Optician Services to Contra Costa Health Plan through September 30, 1996. CONTINUED ON ATTACHMENT: YES SIGNATURE: x"/ RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE APPROVE OTHER SIGNATURE(S) _74 ACTION OF BOARD ON APPROVED AS RECOMMENDED OTHER 1 VOTE OF SUPERVISORS UNANIMOUS (ABSENT ) I HEREBY CERTIFY THAT THIS IS A TRUE AYES: NOES: AND CORRECT COPY OF AN ACTION TAKEN ABSENT: ABSTAIN: AND ENTERED ON THE MINUTES OF THE BOARD Contact: Milt Camhi (313-5604) OF SUPERVISORS ON THE DATE SHOWN. CC: Health Services (Contracts) ATTESTED d 9f-3— Risk Management Phil Batchelor,Clerk of th Baard of Auditor-Controller Supervisors 2nd County Administrator Contractor , M382/7-83 BY DEPUTY Contra Costa County Standard Form (8/95) HEALTH SERVICES SHORT FORM SERVICE CONTRACT Numbar: 27-056-5 (Non-Physician Services Only) Fund/Org# 6106 Account # 1. Contract Identification. _4 Department: Health Services Department- Contra Costa Health Plan Subject: Optician Services 2. Parties. The County of Contra Costa, California (County) , for its Department named above, and the following named Contractor mutually agree and promise as follows: Contractor: ROBERT TURCIOS, O.D. Capacity: Self-employed individual Taxpayer ID# 549-42-3499 Address: 14240 San Pablo Avenue, San Pablo, California 94806 3 . Term. The effective date of this Contract is October 1, 1995 and it terminates September 30, 1996 unless sooner terminated as provided herein. 4. Termination. This contract may be terminated by County, at its sole discretion, upon (30) days advance written notice thereof to Contractor, or may be canceled immediately by written mutual consent. 5. County's Obligation and Method of Payment. County shall make to Contractor those payments described in paragraph 1. (Payment) of the attached Additional Provisions which are incorporated herein by reference. 6. Contractor's Obligations. Con actor shall provide those services set forth in Attachment A, "Contra Costa Heal ontract Requirements, " attached hereto and incorporated herein, to Contra C h. H _ Plan members. Contractor shall also provide optician services, including appropri e " wear, as prescribed and authorized by Contra Costa Health Plan, as set forth in the attached Additional Provisions which are incorporated herein by reference. 7. Independent Contractor Status. This Contract is by and between two independent contractors and is not intended to and shall not be construed to create the relationship of agent, servant, employee, partnership, joint venture, or association. 8. Compliance with Law. Contractor shall be subject to and comply with all Federal, State and local laws and regulations applicable with respect to its performance hereunder, including but not limited to, licensing, employment and purchasing practices; and wages, hours and conditions of employment. 9. Modifications and Amendments. This Contract may be modified or amended by a written document executed by the Contractor and the Contra Costa County Board of Supervisors or, after Board approval, by its designee, subject to any required State approval. 1 Contra Costa County Number: 27-056-5 Standard Form (8/95) HEALTH SERVICES SHORT FORM SERVICE CONTRACT (Non-Physician Services Only) 10. Insurance and Indemnification. Throughout the term of this Contract, Contractor shall maintain professional liability insurance with a minimum coverage limit of $50, 000 per claim/$100, 000 annual aggregate for all damages or losses because of errors, omissions, or malpractice arising from the provision of professional services under this Contract. If a claim is made against County, or its officers, agents, or employees, which arises out of the performance of Contractor's duties under this agreement and Contractor has failed to maintain the insurance policies required under this agreement which would have covered Contractor had the claim been made against him or her, then as to such claims, Contractor shall indemnify and hold the County, and its officers, agents, or employees harmless for that portion of the loss or liability attributable to Contractor. 11. Disputes. Disagreements between the County and Contractor concerning the meaning, requirements, or performance of this Contract shall be subject to final determination in writing by the head of the County Department for which this Contract is made or his/her designee or otherwise in accordance with the applicable procedures (if any) required by the State or Federal Government. 12. Legal Authority. This Contract is entered into under and subject to the following legal authorities: California Government Code Sections 26227 and 31000 and all legal authorities cited in Attachment A, "Contra Costa Health Plan Subcontract Requirements, " attached hereto and incorporated herein. 13. Signatures. These signatures attest the parties' agreement hereto: COUNTY OF CONTRA COSTA, CALIFORNIA CONTRACTOR By By (Designee) Approved: County Administrator (Designate official capacity) By (Designee) Recommended by Department (Form approved by County Counsel] By (Designee) 2 ADDITIONAL PROVISIONS Number 27-056-5 1. Payment. In consideration of Contractor's provision of services and products, County shall pay Contractor as follows: a. Commercial Health Plan Members. For commercial members of the Contra Costa Health Plan, upon submission of a properly documented billing form prescribed by County and upon approval of such form by Health Services Director or his/her designee, County shall pay Contractor: (1) °Vision Exams $50.00 °Single Vision Lenses $25.00 °Bifocal Lenses $40.00 OTrifocal Lenses $65.00 °Lenticular Lenses $65.00 °Frames $40.00 °Contact Lenses (only if medically necessary) $65.00 (2) The maximum payment for combined lenses and frames OR contacts lenses is $65.00 per year, per commercial Health Plan member. (3) Vision Exams are limited to one per year, per member. (4) Contractor may charge the commercial Health Plan member the difference between the retail price of the vision care product and the maximum payment set forth above. Before determining the member's share of cost, Contractor shall discount the regular retail price of the vision care product by at least 10 percent. b. All Other Health Plan Members. For all other members of the Contra Costa Health Plan, County shall pay Contractor the current Medi-Cal rate for like services and products, upon submission of a properly documented demand for payment as prescribed by County, and upon approval of said demand by Health Services Director or his/her designee. 2. Endorsements. Contractor shall not in its capacity as a contractor with Contra Costa County publicly endorse or oppose the use of any particular brand name or commercial product without the prior approval of the Board of Supervisors. In its County contractor capacity, Contractor shall not publicly attribute qualities or lack of qualities to a particular brand name or commercial product in the absence of a well-established and widely accepted scientific basis for such claims or without the prior approval of the Board of Supervisors. In its County contractor capacity, Contractor shall not participate or appear in any commercially-produced advertisements designed to promote a particular brand or commercial product, even if Contractor is not publicly endorsing a product, as long as the Contractor's presence in the advertisement can reasonably be interpreted as an endorsement of the product by or on behalf of Contra Costa County. Notwithstanding the foregoing, Contractor may express its views on products to other contractors, the Board of Supervisors, County officers or others who may be authorized by the Board of Supervisors or by law to receive such views. Initials: Contractor County Dept. ATTACHMENT A CONTRA COSTA HEALTH PLAN SUBCONTRACT REOUIREMENTS Number: 27-056-5 Pursuant to State Department of Health/County Contract #88-94695 (County #29-609-35) , effective January 1, 1989, (or the latest revision) Article X, Subcontracts; requirements of the Waxman-Duffy Prepaid Health Plan Act, (1972) and Knox-Keene Health Care Service Plan Act of 1975; Federal Regulations: 42 CFR 431.504; State Law: W&I Code, Section 14452; State Regulations: Title 22, CCR, Section 53250, the following subcontract requirements are incorporated into the contract referenced by number above: 1. Contractor shall be subject to and comply with all Federal, State, and local laws and regulations and contractual obligations incumbent upon the County under County Contract #29-609-35 and any subsequent amendment thereto. 2. A Contractor providing any basic health care service to Contra Costa Health Plan members (Plan members) shall meet all of the requirements of Chapters 3 and 4, Subdivision 1, Division 3, Title 22, C.A.C. (commencing with Section 51001) which relate to the services the Contractor provides. This specifically includes the requirements of Title 22, C.A.C. Section 53250 (e) , a copy of which is attached hereto and incorporated herein by reference as Exhibit A. 3 . Contracts shall be public records on file with the State Department of Health Services. The names of the officers and owners of the Contractor, stockholders owning more than ten percent of the stock issued by the Contractor, and major creditors holding more than five percent of the debt of the Contractor are: Owners/Officers: Stockholders owning more than 10% of stock: Creditors holding more than 5% of debt: 4. County and Contractor agree that Contractors compensation hereunder shall not be based in any way on a percentage of the County's compensation from the State Department of Health Services; this agreement does not preclude the establishment of Contractor's rate based on capitation payments pursuant to Welfare and Institutions Code Section 14453. 5. Contractor agrees to submit reports or abstracts of treatment records in relation to Plan members, as appropriate and required by County. 6. Contractor will allow inspection, examination, or copying of financial books and records relating to Plan members, subscribers or Plan services by the County, the State Department of Health Services, the State Department of Corporations, the U.S. Department Health and Human Services, or their duly authorized representatives. Such books and records shall be made available at all reasonable times at the Contractor's place of business; in a form maintained in accordance with general standards, for a term of at least five years from the close of State's fiscal year in which this Contract is in effect. Initials: Contractor County Dept. -1- ATTACHMENT A CONTRA COSTA HEALTH PLAN SUBCONTRACT REQUIREMENTS 7. Contractor shall not make assignment and/or delegation of this Contract unless it has obtained prior written approval of the other party, the County, and State Department of Health Services. 8. Contractor will hold harmless both the State and Plan members in the event the County cannot or will not pay for services performed for Plan memberspursuant to this Contract. 9. Contractor will notify the Department of Health Services and Commissioner of Corporations in the event this Contract is amended or terminated. Notice is considered given when deposited in the U.S. Registered Mail, first class postage prepaid, addressed as follows: Organized Health Services HMO Unit Department of Corporations Department of Health Services 600 South Commonwealth 714 P Street Los Angeles, California 90005 Sacramento, California 95814 10. Nondiscrimination Requirements. a. Nondiscrimination Clause (OCP-1) . (1) During the performance of this Contract, Contractor and its subcontractors shall not unlawfully discriminate against any employee or applicant for employment because of race, religion, color, national origin, ancestry, physical handicap, medical condition, marital status, age (over 40) or sex. Contractor and subcontractors shall insure that the evaluation and treatment of their employees and applicants for employment are free from such discrimination. Contractors and subcontractors shall comply with the provisions of the Fair Employment and Housing Act (Government Code, Section 12900 et seq. ) and the applicable regulations promulgated thereunder (California Code of Regulations, Title 2, Section 7285.0 et seq. ) . The applicable regulations of the Fair Employment and Housing Commission implementing Government Code, Section 12990, set forth in Chapter 5 of Division 4 of Title 2 of the California Code of Regulations are incorporated into this Contract by reference and made a part hereof as if set forth in full. Contractor and its subcontractors shall give written notice of their obligations under this clause to labor organizations with which they have a collective bargaining or other agreement. (2) This Contractor shall include the nondiscrimination and compliance provisions of this clause in all subcontracts to perform work under this Contract. b. Nondiscriminatory Services. The Contractor will not discriminate against Contra Costa Health Plan members, subscribers or eligible beneficiaries because of race, color, creed, religion, ancestry, marital status, sexual orientation, national origin, age, sex, or physical or mental handicap in accordance with Title VI of the Civil Rights Act of 1964, 42 USC Section 2000d rules and regulations promulgated pursuant thereto, or as otherwise provided by law or regulation. Initials: Contractor County Dept. -2- ATTACHMENT A CONTRA COSTA HEALTH PLAN SUBCONTRACT REQUIREMENTS C. Discrimination Complaints. The Contractor agrees that copies of all grievances alleging discrimination against Contra Costa Health Plan members or eligible beneficiaries because of race, color, creed, sex, religion, age, national origin, ancestry, marital status, sexual orientation, or physical or mental handicap shall be forwarded to the Health Services Director for review and appropriate action. 11. Confidentiality. Contractor agrees to comply with all applicable State or Federal statutes or regulations respecting confidentiality, including but not limited to, the identity of persons served under this Contract, their records, or services provided them, and assures that: a. All records concerning any individual made or kept by Contractor relating to services provided under this Contract will be confidential, and will not be open to examination for any purpose not directly connected with the administration of such service. b. No person will publish or disclose any list of persons receiving services, except as may be required in the administration of such service. Initials: Contractor County Dept. -3- EXHIBIT A TITLE 22 MEDICAL ASSISTANCE PROGRAM Section 53250 (Register 82. No. 39--5-25-82 (p, 1300.39) (e) Each subcontract shall contain: (1) The subcontractor's agreement to make all of its books and records, pertaining to the goods and services furnished under the terms of the subcontract, available for inspection, examination or copying: (A) By the Department, the United States Department of Health and Human Services and the Department of Corporations. (B) At all reasonable times at the subcontractor' s place of business, or at such other mutually agreeable location in California. (C) In a form maintained in accordance with the general standards applicable to such book or record keeping. (D) For a term of at least five years from the close of the fiscal year in which the subcontract was in effect. (2) Full disclosure of the method and amount of compensation or other consideration to be received by the subcontractor from the plan. (3) Subcontractor's agreement to maintain and make available to the Department, upon request, copies of all sub-subcontracts and to ensure that all sub-subcontracts are in writing and require that the subcontractor: (A) Make all applicable books and records available at all reasonable times for inspection, examination or copying by the Department. (B) Retain such books and records for a term of at least five years from the close of the fiscal year in which the sub-subcontractor is in effect. (4) Subcontractor's agreement to notify the Department in the event the agreement with the Contractor is amended or terminated. Notice to the Department is considered given when properly addressed and deposited in the United States Postal Service as first-class registered mail, postage attached. (5) Subcontractor's agreement that assignment or delegation of the subcontract shall be void unless prior written approval is obtained from the Department in those instances where prior approval by the Department is required. (6) Subcontractor's agreement to hold harmless both the State and plan members in the event the plan cannot or will not pay for services performed by the subcontractor pursuant to the subcontract. NOTE: Authority cited: Section 14312, Welfare and Institutions Code Reference Section 14452, Welfare and Institutions Code. HISTORY 1. Repealer and new section filed 7-5-78, effective thirtieth day thereafter (Register 78, No. 27) . 2. Amendment of subsection (g) (16) and new subsection (g) (17) filed 10-20-78, effective thirtieth day thereafter (Register 78, No. 42) . 3 . Amendment filed 12-30-81; effective thirtieth day thereafter (Register 82, No. 1) .